DUTCH Hormone Testing

As many of you know, I recently completed an EXTENSIVE training on reviewing DUTCH tests.  I spent over 20 hours reviewing and studying every marker in the DUTCH test.  Not only did I complete online training modules, and watch live classes with case studies, but I also read every single related piece of published research there was to read. Every. Single. Study.

Could I have run DUTCH tests and reviewed them without the additional training?  Absolutely, as someone who specializes in Women’s Health, I did not NEED the training to give a basic interpretation, but I wanted it. Why? I wanted to know if running the test on my clients would be worth it.  For years I’ve been getting serum levels for my clients under insurance by requesting their doctors to run them.  I’ve never had a Doctor say no, but one time I did have one call me and ask me why.  I explained they ordered the test and end of the interaction.  So why now?  We will get to that, but let’s first discuss what DUTCH hormone testing is. 

There are many different types of DUTCH tests. Today I will focus on the DUTCH complete and the DUTCH complete plus.  I’ll write about DUTCH cycle mapping at a later date.  

WHAT IS THE DUTCH HORMONE TEST?

From the DUTCH website “The DUTCH Complete™ is the most advanced hormone test, offering an extensive profile of sex and adrenal hormones and melatonin, along with their metabolites, to identify symptoms of hormonal imbalances.”

The DUTCH test stands for Dried Urine Test for Comprehensive Hormones and involves collection of a small amount of urine on filtered paper four times a day. The DUTCH TEST measures hormone metabolites from the dried urine samples. The hormones measured in the test include:

• Adrenal Markers: Cortisol and Cortisone
• Estrogen and Estrogen Metabolites: Estradiol, Estrone, and Estriol
• Progesterone: Total Progesterone
• Testosterone and Estrogen Metabolites: Testosterone, Androsterone, and Etiocholanolone
• DHEA-S
• Melatonin 
• 10 Organic Acids:  Vitamin B12 markers, Vitamin B6 markers, Glutathione markers, biotin markers, gut markers, dopamine markers, Norephineprhine/epinephrine metabolite markers, neuroinflammation markers, oxidative stress, DNA damage markers, and melatonin. 

This test also measures cortisol and cortisone rhythms throughout the day and estrogen metabolism pathways, giving us insight into how well the liver is handling metabolizing the hormones being produced.  

How is DUTCH different from a serum/blood draw? 

For years I used serum draws ordered by my client’s OBGYN or Primary care to evaluate Estrogen, Progesterone, and Testosterone to evaluate hormone balance vs. symptoms they were experiencing. 

And while we could get started on the heavy hitters like anti-inflammatory hormone-balancing diets, supporting liver detoxification, basic supplements, and lifestyle modifications, I knew many of them needed more.  Many of them were not getting to the 100% symptom-free standard I wanted them at.  Why?

1.  Serum/blood values look at a one-point draw. Urine testing uses a weighted average.  Since hormones pulse throughout the day, you could get really high numbers or really low numbers in a blood draw that aren’t indicative of what’s happening throughout the day.  
2. Metabolites or other forms of hormones could be driving symptoms that are not tested in standard clinical practice. Ex. I had a client with Testosterone dominant symptoms but always normal blood draws testosterone. It turns out she favors breaking down testosterone into a metabolite that is very androgenic (binds strongly to testosterone receptors), causing symptoms of high testosterone.  

3) Serum/blood test values of cortisol are only performed in the AM and give you no insight into cortisol rhythm throughout the day or how your body is metabolizing the cortisol you do produce, if you produce enough at all.  

So, in other words, it’s a DEEPER dive into hormones than you can get with traditional blood testing, and you get a better picture throughout the day.  

How Does A DUTCH Test Review Work? 

After the test is complete (at-home urine test collection) and the results are in, it’s time to review your test.  With the first round of clients I tested, I sat with them for 1-2 hours, going through every single marker on the test. There is a lot!  

But the real question is, how do my recommendations change compared to if I didn’t use a DUTCH test with my clients?

Well, some of the very important recommendations wouldn’t change – heavy hitters like an anti-inflammatory diet and lifestyle need to be addressed with or without a test in most cases. In fact, no supplement I recommend will matter at all if these aren’t addressed. The difference is, from the client’s perspective (you) can clearly see WHY I’m making the recommendations I’m making.  Would I have made them anyway?  Sometimes, but not always.  For example, I will always tell a PCOS client to get rid of plastic and endocrine disruptors in their life because there is strong research to support that this change leads to improved ovarian function and improved fertility.  But, for a client without PCOS, the endocrine disruptor issue (plastics, BPA, etc.) may only come up if we see an estrogenic dominance or a favor of more carcinogenic metabolites on their test. 

I also would be more likely to discuss endocrine disruptors if there are indicators that there are potential problems with detoxification pathways or estrogen dominance on the test. So, yes, I believe the test helps direct and personalized recommendations in a way that general nutrition counseling may not, even if the heavy hitters stay the same (diet and lifestyle.) The cortisol information helps tailor exercise and recovery schedules in a way you can’t do without seeing the four-point draw.  But note you can get cortisol salivary tests separate and cheaper than the DUTCH test.  I have sent clients to them before and have used them for years since I worked at the gym. But, paired with hormone information, they are even more valuable. 

Who Is DUTCH Testing For?

When lifestyle and anti-inflammatory nutrition interventions haven’t fully improved symptoms and any of the following:

• Adrenal fatigue, sleep, or stress issues are suspected. 

• Fertility problems, polycystic ovarian syndrome (PCOS). This test is beneficial for people suffering from fibroids, PMS, irregular periods, painful periods, anxiety & moodiness, and endometriosis. 

• Assessment of Hormone replacement therapy. 

• Strong family history of breast cancer. 

It’s for clients who want to dive deeper into their health and get a really personalized view of what’s going on with their hormone balance.  We can also personalize your exercise and recovery interventions based on the cortisol pattern we observe on the test. It also may give us great insight into where we need to direct efforts for further testing, like, for instance, if we see GI inflammation markers show up.  Or we see signs of nutrient deficiency.  More importantly, it’s a great way to track what’s going on with your entire hormone system and the adrenal system as you carry out interventions. 

Who Is Not A Candidate For DUTCH Testing?

This test is “nice to have,” not “have to have,” and with the clients below, I wouldn’t run it.  

• Pregnant or Post-Partum Women (Up to 3 Months)
• Breastfeeding Women (until >9 months PP)
• Those on a really strict budget 
• Those who haven’t completed an initial workup from their doctor
• Those who are on certain contraceptives

If a client is starting out and is maybe just working on getting a diagnosis for their endometriosis, PCOS, or otherwise, I wouldn’t run a DUTCH test.  I’d prefer to have the ultrasounds, etc., and the conventional medicine doctor’s evaluation before I test and implement lifestyle interventions.  This is true when I do food sensitivity testing as well.  I often require my clients to get a diagnosis from their GI doctor (such as IBS) and, at minimum, screen for celiac before we start.  I’m not a doctor. I’m not even a functional medicine doctor. I’m a Dietitian specializing in functional nutrition.  

Is DUTCH testing worth it? 

Functional Medicine Criticism of Blood Testing

The criticism in the functional medicine world is that DUTCH testing is the gold standard and that conventional doctors don’t know how to address root-cause issues or don’t have the tools.  First of all, what doctor do you know has the time to spend 2 hours reviewing bloodwork with someone and discussing every aspect of stress, sleep, and food with them?  None of them. But unfortunately, diet and lifestyle are the heavy hitters, so there are Dieititnas (me) to take the time to do this. Also, supplements are not as vigorously studied as medications.  Medications have billions of dollars of research behind them to ensure effectiveness, and supplements usually only nudge an improvement. They do nothing without diet and lifestyle. Doctors use medication to help you feel better immediately and the occasional supplement here and there. Conventional surgeons will save your life in an emergency situation. Let’s not hate conventional medicine as it has its place.  

Conventional Medicine Criticism of Urine Testing

The criticism in the conventional medicine world is that this type of testing is just a way to “sell you supplements.”  I find this kind of offensive, although I know why they say this. First of all, every single functional doctor or practitioner will tell you that supplements will do absolutely nothing if you don’t make the recommended diet and lifestyle changes.  I say this about 8 thousand times during the DUTCH test review (unless the client has already made big changes.) I know that some functional practitioners take huge cuts on supplements and go way overboard, but I don’t. I could go on a whole speech about this, but I won’t. I’ll just say that functional medicine providers use testing to personalize supplement protocols instead of just throwing supplements researched for general conditions at you.  They have their place, so let’s not hate on them either. 

Final Thoughts On DUTCH Testing

I like to think that I straddle the line between conventional and functional medicine.  I deeply respect both approaches and try to blend the best of both worlds the best I can.  I recognize that the side effects of conventional medications are understated but that supplements are not long-term options either. 

In this case, after extensive training and feedback from my clients, I believe the added value of this test is something I don’t want my clients to miss out on, which is why I will be offering DUTCH testing from now on!

I also believe that many functional practitioners gloss over nutrition as part of the discussion when really it should be the main focus of a DUTCH test review.  Another reason I think Registered Dietitians with the right training are the right people to review this test. Most Dietitians have Master’s degrees in which they gained an extensive understanding of metabolic pathways that nutritionists with certifications (I don’t care which certification) do not have. I have many friends in the functional nutrition space, and they are great amazing, wonderful practitioners, but I believe RDs are posed to be better practitioners given the right training. 

I wonder, if I had done a DUTCH test, would it have taken me five solid years to get my period back after coming off oral contraceptives?  I don’t think it would have taken quite so long because there would have been unequivocal evidence through the cortisol and cortisone metabolites that I was stressing my body the F out.  I would have had a chance to discuss with someone that the NSAIDS I was on were hormone-suppressing and that I lacked nutrients from long-term dieting and long-term OC use.  In other words, there would have been no hiding from the facts and less confusion about whether I had PCOS or Hypothalmic Amenorrhea, or just Post Pill Syndrome. But eventually, I did figure it out without the DUTCH test, but how much suffering in between?  And bone loss from lack of Estrogen production…. can’t wait to find that out at a DEXA scan.  So, both short-term and long-term consequences from fighting my way through instead of using testing. And wasted time, stress, and money on supplements that didn’t actually apply to me. 

Clients Feedback After DUTCH Testing

The number one comment I’ve received so far is how validated my clients feel after seeing the test.  They struggled for years with symptoms that weren’t fully explained by conventional blood draws, and to see the whole picture was incredibly validating.  

For many who have tried standard PCOS or other women’s health protocols, to see whether it was working or where they could target more was invaluable.  

How Much Does DUTCH Testing Cost?

The cost below is the current wholesale price to me.  This means I send you directly to the lab to pay this amount to the company for the test.  Remember that you will also need to pay for an appointment to review the test, as it’s kind of worthless without someone to interpret it for you! And as much as I would love to do that for free, I obviously have to make a living as a Dietitian. It is my understanding that these items are all (including appointments with me) HSA/FSA eligible, but general insurance won’t pay for them. 

The DUTCH Complete ($300) shows a comprehensive assessment of 20 sex hormone metabolite markers (2 Progesterone, 8 Androgen, and 10 Estrogen), 12 adrenal hormone metabolite markers (4 Cortisol, 4 Cortisone, 3 Cortisol Metabolites, 4 Creatinine, and DHEA-S), 6 Organic Acids, 8-OHdG, and Melatonin. All these markers are taken from a one-day, 4-spot urine collection. 

TOTAL PRICE  ($499-$549)

The DUTCH Plus ($400) includes all the biomarkers of the DUTCH Complete (2 Progesterone, 8 Androgen, and 10 Estrogen, 3 Cortisol metabolites, 4 Creatinine, DHEA-S, 6 Organic Acids, 8-OHdG, and Melatonin markers taken from a one-day, 4-spot urine collection) but also adds 4 salivary measurements to assess the Cortisol Awakening Response (CAR) by adding 5-6 Free Cortisol and Cortisone points each, taken throughout the day. The CAR assessment collects salivary samples at the moment of waking and twice more, at 30 and 60 minutes after waking to bring another important piece of the HPA Axis into focus or if suspected adrenal disfunction is prevalent. 

TOTAL PRICE ($599-$649)

How to Sign Up For a DUTCH Hormone Test

I have decided to implement a consult system similar to what I do with food sensitivity testing.  If you are unsure, a 30-minute consult will help determine if you are a good candidate for the test.  The cost of the consult will then be applied toward either your testing package or just general nutrition counseling. Whatever we decide together is best for you! So although the consult is an initial investment, it ends up being free. 

New Clients: Sign up for your DUTCH consult now, or if you are 100% confident you want to do the testing, sign up here.  

Current Clients:  Reach out to Kelli for pricing and a sign-up link. You will have a slightly lower price on your review appointment if we have already been working together already, as the appointment won’t be quite as long.